Leak and Scattering Assessment by Optically Stimulated Luminescence Dosimetry in a Helical Linear Accelerator / Valoración de Fuga y Dispersión por medio de Dosimetría de Luminiscencia Estimulada Ópticamente (OSL) en un Acelerador Lineal Helicoidal

Radiation absorbed doses to organs outside the radiation therapy treatment beam can be significant and therefore of clinical interest. Two sets of out-of-beam measurements were performed measuring the leak dose and the scattered dose, at 5 points within the accelerator components (accelerator tube and collimator) and at 21 points on the equipment and surroundings based on a positioning scheme. For this purpose, 52 Optically Stimulated Luminescence (OSL) dosimeters were used in a latest generation helical linear accelerator. Of the 200 cGy fired at a cheese-like phantom, 0.332% of the out-of-beam dose contribution was found to come from the leak and 0.784% was transformed into scattering. For these dose values, estimates of the risk of second tumors in long-term survivors indicate a reduced probability of acquiring a second secondary radiation malignancy, based on information from the 1990 BEIR Committee report.

La dosis absorbida de radiación a órganos fuera del haz de tratamiento de radioterapia puede ser significativa y, por lo tanto, de interés clínico. Se realizaron dos sets de mediciones fuera del haz para determinar la dosis de fuga y la dosis dispersa, en 5 puntos dentro de los componentes del acelerador (tubo de aceleración y colimador) y 21 puntos en el equipo y alrededores basado en un esquema de posicionamiento. Para este fin se utilizaron 52 dosímetros de luminiscencia estimulada ópticamente (OSL, Optically Stimulated Luminescence), en un acelerador lineal helicoidal de última generación. De los 200 cGy disparados a un maniquí tipo queso, se encontró que el 0.332% de la contribución de dosis fuera del haz provenía de la fuga y 0.784% se transforma en dispersión. Para estos valores de dosis, las estimaciones del riesgo de segundos tumores en los supervivientes a largo plazo indican una reducida probabilidad de contraer una segunda malignidad por radiación secundaria, según la información del informe del Comité BEIR de 1990.

Estimation of the effectiveness ratio (α/ß) for resistant cancer cells in U87MG human glioblastoma.

Glioblastoma contains self-renewing, tumorigenic cancer stem-like cells that contribute to tumor initiation and therapeutic resistance. The aim of this research was to estimate and compare the effectiveness ratio (α/ß) of stem-like cells and differentiated glioma cells derived from the U87MG glioblastoma cell line. Cell survival experiments were obtained in a dose range of 0-20 Gy (13.52 ± 0.09 Gy/h) as a hyperfractionationated accelerated radiotherapy scheme. Biochemical characterization of the post-irradiated cells was performed by flow cytometry analysis and the percentage of stem-like cells that resisted irradiation was determined by the CD133 expression. Results showed that U87MG stem-like cells are highly proliferative and more radioresistant than the U87MG adherent group (with a lesser stem-like character), this in association with the calculated α/ß ratio of 17 and 14.1, respectively.

¹5³Sm-HM for arthritic knee pain. Estimated dosimetry.

Osteoarthritis is the most common type of arthropathy and after cardiovascular diseases is the most disabling disease in developing countries. The dosimetry for the clinical application of 153-samarium-hydroxymacroaggregates (¹5³Sm-HM) for radiation synovectomy (RSV) and palliative treatment for arthritic pain, as far as we know, has not been reported. The aim of this research was to estimate the radiation dose necessary for synovial ablation and pain palliation with minimum risk to the patient. ¹5³Sm-HM (370 MBq) was administered intra-articularly in a patient with severe knee pain and hindered motility. Regions of interest drawn on sequential, conjugated, anterior and posterior scintigraphy images were used to obtain the respective activity. The data was entered into a knee joint histological-geometric model designed with micrometric dimensions to represent the synovial cell layers. The Monte Carlo code was used to calculate the absorbed dose in each of the 12 model-cells representing the distance from the synovial liquid to the cartilage or bone. The absorbed dose in the synovial cavity was 114 Gy which is sufficient energy for RSV. The treated patient referred little pain and higher motility with no adverse reactions. ¹5³Sm-HM is a potentially valid radiopharmaceutical for RSV, which effectively palliates knee pain.

Biokinetics of (99m)Tc-UBI 29-41 in humans.

Antimicrobial peptides have been proposed as new agents to distinguish between bacterial infections and sterile inflammatory processes. (99m)Tc-UBI labeled by a direct method has shown high in vitro and in vivo stability, specific uptake at the site of infection, rapid background clearance, minimal accumulation in non-target tissues and rapid detection of infection sites in mice. The aim of this study was to establish a (99m)Tc-UBI biokinetic model and evaluate its feasibility as an infection imaging agent in humans. Whole-body images from 6 children with suspected bone infection were acquired at 1, 30, 120, 240 min and 24 h after (99m)Tc-UBI administration. Regions of interest (ROIs) were drawn around source organs (heart, liver, kidneys and bladder) on each time frame. The same set of ROIs was used for all 6 scans and the cpm of each ROI were converted to activity using the conjugate view counting method. Counts were corrected by physical decay and by the background correction factor derived from preclinical phantom studies. The image sequence was used to extrapolate (99m)Tc-UBI time-activity curves in each organ and calculate the cumulated activity (A). Urine samples were used to obtain the cumulative percent of injected activity (% I.A.) versus time renal elimination. The absorbed dose in organs was evaluated according to the general equation described in the MIRD formalism. In addition, (67)Ga-citrate images were obtained from all the patients and used as a control. Biokinetic data showed a fast blood clearance with a mean residence time of 0.52 h. Approximately 85% of the injected activity was eliminated by renal clearance 24 h after (99m)Tc-UBI administration. Images showed minimal accumulation in non-target tissues with an average target/non-target ratio of 2.18 +/- 0.74 in positive lesions at 2 h. All infection positive(99m)Tc-UBI images were in agreement with those obtained with (67)Ga-citrate. The mean radiation absorbed dose calculated was 0.13 mGy/MBq for kidneys and the effective dose was 4.34 x 10(-3)mSv/MBq.

Conformal radiotherapy: A review of principles and techniques

Uno de los objetivos de la radioterapia es la utilización de radiaciones ionizantes con el intento de eliminar la máxima cantidad de células tumorales sin dañar seriamente el tejido normal. Para realizar esto, se necesita la delimitación precisa de la dosis tumoricidad en el volumen-blanco y dar una dosis lo más baja posible en todos los tejidos sanos, minimizados simultáneamente la dosis en los órganos de riesgo. A este régimen se le llama radioterapia de conformación. Contra los antecedentes de estos objetivos, la radioterapia convencional se ve limitada para lograrlos. Algunas de las razones para esto podría ser dificultades en la determinación del volumen-blanco en tres dimensiones; en el diseño de haces de radiación adecuadamente delimitados y orientados; en calcular la distribución de dosis resultante de sobreposiciones complejas de haces en tejido heterogéneo y en verificar que el paciente esté correctamente posicionado en el momento de dar el tratamiento, etc. Sin embargo, en los últimos 30 años se han derarrollado varias técnicas dinámicas de radioterapia. Aunque estas técnicas han cumplido los criterios de conformación en un alto grado, su complejidad, la falta de algoritmos precisos y rápidos para calcular la distibución de sodis y la incertidumbre geométrica relativa a la localización, forma y dimensiones del tumor y de los órganos vitales, han limitado seriamente su aplicación en el pasado. Aun así, durante los últimos años se han hecho importantes avances en imagenología, cálculo de dosis, perfeccionamiento de los equipos de tratamiento, así como la introducción de técnicas de optimización en la planeación del tratamiento, lo que implica un avance significativo en el principio de la radioterapia de conformación. Así, parece que ha llegado el tiempo para que las técnicas de conformación se simplifiquen y, al mismo tiempo, se estandarizen para ser integradas, por medio de algoritmos especiales, en el procedimiento de planeación de tratamiento. Así podrán ser fácilmente aplicadas en un gran número de departamentos de radioterapia y, en consecuencia, en una mayor proporción de pacientes con cáncer